Public Awareness, Attitudes, and First-Aid Measures on Epilepsy in Tehran

Objectives People with epilepsy generally encounter misconceptions and negative attitudes on different aspects of the disease. They are also prone to physical injuries during seizures. Lack of awareness about first-aid measures results in taking inappropriate first-aid measures. We aimed to determine the public awareness, attitudes, and first-aid measures about epilepsy in Tehran. Materials & Methods This population-based cross-sectional survey was conducted from Dec 2016 to May 2017 in Tehran, Iran. Random stratified cluster sampling was used. Data were collected through interviews using a questionnaire. The awareness section included general awareness, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section which included 20 statements. The answers about first-aid measures were categorized as helpful, or harmful. Results Overall, 833 adults participated in the survey. The level of total awareness score of 41 (4.9%) participants was very good, 194 (23.3%) good, 255 (30.6%) fair, 210 (25.2%) low, and 133(16.0%) very low. The mean (SD) score about general awareness was 4.6 (3.0), range=0 to 11; causes 5.8 (3.4), range=0 to 13; symptoms of seizures 7.0 (4.0), range=0 to 13; first-aid measures 7.5 (3.4), range=0 to 14. Among all participants, 260 (31.2%), named at least one superstitious cause for epilepsy. Attitudes were generally positive except for marriage and having kids. The level of first-aid measures score of 74(42.5) was very good, 79(45.4) good, and 21(12.1) low. Conclusion The awareness of people of Tehran about epilepsy was insufficient, attitudes were generally positive but rather conservative, and first-aid measures at the last witnessed seizure were fairly helpful.


Introduction
Epilepsy is still stigmatized in most parts of the world (1,2). Public  Lack of public awareness about the nature of epilepsy is directly correlated with the presence of a stigma which results in negative attitudes towards PWE and impairs their quality of life more than the disease itself (2,4). PWE may suffer from stigma and misconceptions in many aspects of life such as employment, education, and social relationships (5,6). Proper awareness about epilepsy could prevent such misconceptions, stigma and experiencing worry and discomfort about PWE (7,8).
PWE are prone to physical injuries subsequent to seizure (9). First-aid measures aim to protect PWE from getting harmed during a seizure. Lack of awareness and misconceptions about firstaid measures increase the chance of not taking helpful measures or taking harmful measures while witnessing a seizure (8). Moreover, to identify educational needs of the society, public awareness, and first-aid measures need to be assessed.
The objective of this population-based survey was to determine public awareness, attitudes, and firstaid measures towards epilepsy in Tehran, Iran. In addition, they were able to leave the interview at any stage.  (12,13), parents of children with epilepsy (14,15), healthcare professionals (16,17), teachers (18,19), and students (20,21); and open-ended interviews with eight experts in the field, including neurologists, public health experts, special educators, and rehabilitation counselors. To analyze participants' attitudes, "I strongly agree" and "I agree" were considered as "I agree";

Materials & Methods
and "I strongly disagree" and "I disagree" were considered as "I disagree". A probability level of less than 0.05 was considered significant.

Results
Overall, 883 individuals participated in the survey.
Interview sessions of 50 individuals were left incomplete and responses of 833 were analyzed.
The mean (SD) age of participants was 36.2 (13.3), range=18 to 80 yr. Other socio-demographic characteristics of participants are shown in Table 1.

Awareness
The mean (SD) total awareness score of participants Participants' awareness about epilepsy is presented in six categories including 1) general awareness, 2) causes, 3) symptoms of seizures, 4) seizure triggers, 5) first-aid measures, and 6) recommended treatments.

General awareness
The mean (SD) score about general awareness about epilepsy was 4.6(3.0), range=0 to 11. Almost two-thirds of participants knew that epilepsy is a non-contagious neurological disorder. However, 438 (52.8%) of respondents did not know for how long PWE should take their medications, and only 95 (11.4%) reported they had to take them lifelong.
The 11 questions about general awareness are presented in Table 2.  (Table 3).

Awareness about symptoms
The mean (SD) awareness score about symptoms of seizures was 7.0 (4.0), range=0 to 13. More than three-fourths of respondents knew that foaming at the mouth and whole body shaking are symptoms of seizures; however, almost half of the respondents ignored falling as a symptom of seizures (Table 4).

Awareness about seizure triggers
In terms of seizure triggers, 576 (69.5%) of respondents knew that not taking anticonvulsants on a regular basis could trigger seizures. Furthermore, almost half of them did not know whether physical exertion could trigger seizures ( Table 5).  Table   6. As many as 93 (11.6%) reported they would  the Internet, and 28 (3.4%) pamphlets and posters.

Sources of information
Participants could name more than one source of information.

Attitudes
Attitudes of participants towards PWE were generally positive, as more than 90% of respondents stated that epilepsy is nothing to hide or be ashamed of, and PWE should inform others of their condition. More details are presented in Table 8.

First-aid measures
The mean (SD) safe first-aid measures score of participants at the last witnessed seizure was We recommend that the audiovisual media be used